Guidelines Summary
Clinical practice guidelines on anorectal emergencies by the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) were published in September 2021 in the World Journal of Emergency Surgery. [21]
The guidelines on anorectal emergencies published by the WSES and AAST include the following:
In patients who are suspected of having anorectal abscess, it is suggested to check serum glucose, hemoglobin A1C, and urine ketones to identify undetected diabetes mellitus.
In patients who are suspected of having anorectal abscess and who have signs of systemic infection or sepsis, it is suggested to request a complete blood count, serum creatinine, and inflammatory markers (eg, C-reactive protein, procalcitonin, and lactates).
In patients who are suspected of having anorectal abscess, it is suggested to use imaging in cases of atypical presentation and in cases of suspicion of occult supralevator abscesses, complex anal fistula, or perianal Crohn disease. Suggested techniques are MRI, CT scan, or endosonography.
In patients with anorectal abscess, a surgical approach with incision and drainage is recommended.
In patients who have an anorectal abscess and an obvious fistula, it is suggested to perform a fistulotomy at the time of abscess drainage only in cases of low fistula that does not involve sphincter muscle (ie, subcutaneous fistula).
For more information, see Anorectal Abscess, Anorectal Abscess in Children, Anoscopy, and Rectal Foreign Body Removal.
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Rectal Foreign Bodies. Typical appearance of a vibrator in the rectum.
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Rectal Foreign Bodies. Vibrator in the rectum. The patient attempted self-removal with a pair of salad tongs, which also became lodged, resulting in two rectal foreign bodies. Multiple attempts at self-removal are typical in patients with rectal foreign bodies.
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Rectal Foreign Bodies. The patient swallowed a camera pill that became lodged in the rectum at a prior surgical anastomosis site and had to be removed via sigmoidoscopy.
